Abstract
ObjectiveTo study long term consequences of hospitalization for COVID-19 in patients with chronic inflammatory diseases. We studied the risk of subsequent hospitalizations in patients with chronic inflammatory diseases, who survived a hospitalization for COVID-19, compared to other patients who had been hospitalized for COVID-19. Design and SettingPopulation based cohort study based on Danish nationwide health registers. The study population included all adult patients in Denmark who had been discharged alive after a hospitalization with COVID-19 from March 1, 2020 to July 31, 2021. PopulationFrom the study population, the exposed cohort constituted patients who had inflammatory bowel diseases (IBD), rheumatoid arthritis (RA), spondyloarthropathy (SpA), or psoriatic arthritis (PsA) prior to hospitalization for COVID-19, and the unexposed cohort constituted those without these diseases. Main outcome measuresWe estimated the adjusted Hazard Rate (aHR) for the following outcomes: overall risk of hospitalization, cardiovascular diseases, respiratory diseases, blood and blood-forming organs, nervous system diseases, infections, sequelae of COVID-19, and death. ResultsA total of 417 patients with IBD/RA/SpA/PsA were discharged alive after COVID-19, and 9,248 patients without these diseases. Across the different outcomes examined, the median length of follow up was 6.50 months in the exposed cohort (25–75% percentiles: 4.38–8.12), and among the unexposed the median time of follow up was 6.59 months (25–75% percentiles: 4.17–8.49). Across different analyses, we consistently found a significantly increased risk of hospitalizations due to respiratory diseases (aHR 1.27 (95% CI 1.02–1.58)) and infections (aHR 1.55 (95% CI 1.26–1.92)). In sensitivity analyses, the overall risk of hospitalization was aHR 1.15 (95% CI 0.96–1.38) and the risk of hospitalization due to cardiovascular diagnoses was aHR 1.14 (95% CI 0.91–1.42). During the time of follow up, the risk of nervous system diagnoses or death was not increased in patients with IBD/RA/SpA/PsA. ConclusionsAfter hospitalization with COVID-19, patients with IBD/RA/SpA/PsA had an increased risk of subsequent hospitalizations for a number of categories of diseases, compared to other patients who have been hospitalized with COVID-19. These results are disturbing and need to be examined further. The implication of our results is that clinicians should be particularly alert for post COVID-19 symptoms from several organ systems in patients with IBD/RA/SpA/PsA.
Highlights
The coronavirus SARS-CoV-2, which is responsible for the disease COVID-19, has caused morbidity and mortality at an un precedented scale [1,2]
COVID-19 is mostly well-known for causing substantial respiratory pathology, it can result in several extrapulmonary manifestations, and post COVID-19 symptoms have been related to many organ systems
Based on Danish nationwide data, on patients with inflammatory bowel diseases (IBD)/rheumatoid arthritis (RA)/SpA/psoriatic arthritis (PsA) who were discharged alive after a COVID-19 hospitalization, we aim to examine the risk of hospitalizations and death, compared to discharged patients without these diseases
Summary
The coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which is responsible for the disease COVID-19 (coro navirus disease 2019), has caused morbidity and mortality at an un precedented scale [1,2]. COVID-19 is mostly well-known for causing substantial respiratory pathology, it can result in several extrapulmonary manifestations, and post COVID-19 symptoms have been related to many organ systems (pul monary, hematologic, cardiovascular, neuropsychiatric, endocrine, etc.). It is a matter of discussion how to define “long-term”, and there is no strict definition of “long-term” in terms of post COVID-19 symptoms. For those who were survivors among the first infected in the start of 2020, we have approximately 11⁄2 years of follow-up data (as of August 2021). In this paper we prefer to use the term “post COVID-19”
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